Provider Demographics
NPI:1558487108
Name:OPEN-SIDED MRI OF BARTLESVILLE , LLC
Entity Type:Organization
Organization Name:OPEN-SIDED MRI OF BARTLESVILLE , LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:WEYTON
Authorized Official - Middle Name:WING-HO
Authorized Official - Last Name:TAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:918-333-9674
Mailing Address - Street 1:PO BOX 25016
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73125-0016
Mailing Address - Country:US
Mailing Address - Phone:918-333-9674
Mailing Address - Fax:918-333-9675
Practice Address - Street 1:4160 SE ADAMS RD
Practice Address - Street 2:BLDG B
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-8410
Practice Address - Country:US
Practice Address - Phone:918-333-9674
Practice Address - Fax:918-333-9675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1200XAmbulatory Health Care FacilitiesClinic/CenterMagnetic Resonance Imaging (MRI)